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Neurology (Expert Forum)
Slow onset of left foot 'Sticking' to floor'
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Slow onset of left foot 'Sticking' to floor'
by Archbishop, Aug 02, 2006 12:00AM
My 78 yr old Mother is a "complete mystery" to 4 neurologists at UMass Medical Center in Worcester, MA (Teaching Hospital). Starting approx. 3 yrs ago, she complained she was "walking funny" that her left foot was "swinging out to the left". It also got progressively "heavy" over time. Then, over the past year, her left foot got "so heavy that I can barely walk", she says. She does have moderate edema, but due to mild kindey disease, cannot take anything to elimiate it. For various personal and financial reasons, she has been extremely sedate over the past three years, sitting in living room virtually 95% of all days in year, if not more, so very little exercise no walking to speak of. Her MD's have ordered 3 MRI's of head and neck - all NORMAL for person her age. MRA also normal. X-Rays of back and hips normal. She is progressively getting worse to the point that she uses a quad cane and I have to help her walk now as she states that her "foot sticks to the floor" or that it is "so heavy, like lead, that I can't lift it off the floor". All neuro exam NORMAL, including Myerson's sign. No signs dementia at all. Tried, with no positive changes - but could not tolorate - Sinemet, Neurontin, Clonipin.
Also, I'm trying to find movement expert in Boston area to bring her for second opinion. Can you recommend anyone in Massachusetts to me? Or, if not MA, then perhaps New York City as a last resort? My mom's getting more and more despondent over her inability to walk without my assistance, and she's fallen a couple of times already. Please help!
Also, I'm trying to find movement expert in Boston area to bring her for second opinion. Can you recommend anyone in Massachusetts to me? Or, if not MA, then perhaps New York City as a last resort? My mom's getting more and more despondent over her inability to walk without my assistance, and she's fallen a couple of times already. Please help!
Doctor's Answer
by CCF-Neuro-M.D.-SH, Aug 02, 2006 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes. The history and symptoms you describe are most consistent with a possible L5 radiculopathy. As we age, and especially if we do not move about/exercise our bones thin, breakdown and can compress the nerves as they exit the spinal column. A very common location is in the lumbar spine (lower back) and the nerves that arise from the 5th lumbar root control the lifting of the foot (this lesion is also called foot drop). Weakness of the leg often results in external rotation and "heaviness". To work up this possibility I would recommend an EMG and a MRI of the Lumbar spine (these were not mentioned in the history).
I am a little confused that you said her exam is "normal", although she is unable to walk unassisted (I suspect she does have some abnormalities, maybe just not what was expected).
Parkinsons disease/parkinsonism often presents with gait problems and causes shuffling gait, freezing when trying to start walking, falls. If she did not respond to sinemet she may have a varient of parkinsons such as multiple system atrophy or progressive supranuclear palsy (although this does not seem to be supported in the history you provided).
Another possibility would be a dystonia (abnormal stiffening of the muscles), but this would be odd to begin for the first time in her 70's unless there was a lesion on the MRI.
If you would like to see a senior expert movement disorder specialist, I would recommend Dr. Stanley Fahn at Columbia University (NY,NY). I hope this has been helpful.
I am a little confused that you said her exam is "normal", although she is unable to walk unassisted (I suspect she does have some abnormalities, maybe just not what was expected).
Parkinsons disease/parkinsonism often presents with gait problems and causes shuffling gait, freezing when trying to start walking, falls. If she did not respond to sinemet she may have a varient of parkinsons such as multiple system atrophy or progressive supranuclear palsy (although this does not seem to be supported in the history you provided).
Another possibility would be a dystonia (abnormal stiffening of the muscles), but this would be odd to begin for the first time in her 70's unless there was a lesion on the MRI.
If you would like to see a senior expert movement disorder specialist, I would recommend Dr. Stanley Fahn at Columbia University (NY,NY). I hope this has been helpful.
